Neurological emergencies comprise a wide range of conditions which include refractory seizures, acute stroke, traumatic brain and spinal cord injury, meningitis and encephalitis, hypoxic-ischemic encephalopathy, and acute neuromuscular conditions. While these may initially appear to represent disparate conditions, they share two important characteristics: earlier treatment is likely necessary to improve patient outcome and logistics of initial patient presentation pose major challenges to clinical trials of treatments fo these conditions. The NINDS Neurological Emergencies Treatment Trials Network has created a national network of hub and spoke hospital systems to facilitate the conduct of streamlined clinical trials for neurological emergencies such as these. SF-NETT: the San Francisco Neurological Emergencies Trials network has been a high-enrolling hub-spoke system during the first 5-year NETT cycle. SF-NETT represents a scalable and flexible network which can be configured and activated to maximize enrollment of eligible patients across a wide range of conditions being studied. Consisting of all San Francisco ambulance destination hospitals, as well as three specially selected geographically non-contiguous spokes (UCSF-Fresno, Queen's Medical Center, and UC Davis), SF-NETT represents a consortium of academic and community hospitals with a catchment population exceeding 4 million. San Francisco General Hospital is a trauma center, stroke center, the SF-EMSA base hospital, and serves as the hub of SF-NETT. Between the hub and participating spoke hospitals, there are 4 designated trauma centers, 7 comprehensive stroke centers, and 4 EMS systems. SF-NETT works directly with NINDS and the NETT Clinical Coordinating Center to conduct multiple concurrent clinical trials of neurological emergencies via the network, with four trials initiated (one completed) during the initial 5-year cycle. This application is for the 5-year renewal of SF-NETT as a hub for the national NETT network.